Your current location

Helping people with rheumatoid arthritis manage their
fatigue

Research at UWE Bristol has led to a process of measuring
fatigue in people with rheumatoid arthritis which has been adopted
internationally in clinical trials and informed interventions that
have improved the quality of life for the many people who
experience impacts from their rheumatoid arthritis.

Improving the quality of life for those with rheumatoid
arthritis

Research at the University of the West of England, Bristol, has
identified that fatigue is a major problem for people living with
rheumatoid arthritis (RA).

The UWE Bristol team of researchers developed a
questionnaire to measure fatigue, and ensured that fatigue is now
measured in every international clinical RA trial. They then
developed and tested a successful self-management intervention that
has significantly reduced fatigue and improved quality of life in
people with RA, and which many clinical teams are utilising in
the UK and internationally.

How important is fatigue in rheumatoid arthritis?

Professor Sarah Hewlett, Arthritis Research UK
Professor of Rheumatology Nursing at UWE Bristol, conducted
research that found that patients consider fatigue to be a
significant and unmanageable problem, often ignored by health
professionals. Professor Hewlett and her team showed for the first
time that patients consider fatigue to be a crucial factor
impacting on their quality of life, and rate fatigue as more severe
and more important than the pain of RA.

This resulted in international agreement by patients and health
professionals that fatigue must be measured as a core outcome in
all RA clinical studies. The team then developed and
validated the
Bristol RA Fatigue Scales (BRAFs) to measure fatigue
severity, coping and impact. These scales are free for use and have
been translated into almost 40 languages for use world-wide.

How we have helped patients

Professor Hewlett’s team tested the use of group cognitive
behavioural therapy (CBT) for RA fatigue.
CBT works by helping people understand the
links between the thoughts and feelings that drive their
behaviours, which might be making fatigue worse. For example, why
do they keep going when they know they should rest?

Patients that took part in group CBT reduced the impact and severity of their
fatigue. They also improved their coping skills and their physical
and psychological wellbeing. As a consequence, people recommenced
their valued leisure activities.

As few rheumatology teams have a clinical psychologist to
deliver group CBT, Professor Hewlett’s team has now
trained nurses and occupational therapists to deliver the
CBT approach to patient groups, and is testing
this in seven hospitals.

Making a difference locally, nationally and worldwide

Patients have described the improvement in their quality of life
since receiving CBT as "long-lasting" and "life-changing".
In Scotland, Occupational Therapists are utilising the programme
with "improvements in outcomes and patient experience". An
international RA patient panel has testified to improvements in
clinical practice internationally, describing these as
"groundbreaking… fatigue is no longer denied, dismissed or
neglected."

Professor Hewlett’s team also wrote an Arthritis Research UK
booklet on fatigue self-management, which is now stocked in all
rheumatology clinics across the UK. Over 82% of UK rheumatology
nurse specialists are now using the booklet to support patients,
98% find it helpful for patients, and 83% do not require further
fatigue information (compared to 35% six years earlier).

UWE Bristol’s research into fatigue is cited in the standards
for UK service provision - British Society of Rheumatology and
British Health Professional in Rheumatology Guidelines for managing
RA -
which states that fatigue must be addressed.

In 2012, Hewlett’s presentation of the CBT
research, transmitted to 15 hospitals across British Columbia in
Canada, led to a change in clinical practice. The programme leader
reported clinical staff were "using the work of Professor Hewlett’s
team to better assist clients" helped by the provision of "tangible
resources."

The Arthritis Society of Canada has used the fatigue
self-management materials to develop an online fatigue module for
Canadians living with arthritis, and the international
pharmaceutical industry has highlighted how the work has helped
place fatigue at the centre of drug development, being referred by
one world-wide company (UCB) as a "breakthrough… critical in the
drug development process."